Unilateral Lateral Rectus Paralysis Showing Incomplete “V” Sign’ on 18F-FDG PET/CT Extraocular muscles show physiologic radiotracer uptake on 18F-FDG PET/CT as is encountered in most routine scans. Certain pathologies can cause palsy of one or more of the extraocular muscles, leading to hypometabolism on 18F-FDG PET/CT. We present a case with a classical finding of unilateral hypometabolism of the lateral rectus muscle, disrupting the “V” sign formed due to physiologic uptake. The patient had presented with the complaint of diplopia and was being evaluated further to rule out the possibility of inflammatory/granulomatous infectious etiopathogenesis leading to compression of the abducens nerve resulting in lateral rectus palsy. Received for publication April 24, 2019; revision accepted July 13, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Bhagwant Rai Mittal, MD, DNB, Professor & Head, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012. E-mail: brmittal@yahoo.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

FDG PET/CT of Cervical Gout With Spinal Cord Compression We report FDG PET/CT images of a 63-year-old woman referred for characterization of osteolytic lesions of the cervical spine. This patient with chronic renal failure had a history of follicular thyroid carcinoma with undifferentiated cells, treated by a total thyroidectomy, completed by radioactive iodine in 2017. Because of cancer history, a FDG PET/CT was performed and showed multiple moderately hypermetabolic osteolytic lesions of the spine from C3 to T1, with joint erosion on CT. A laminectomy was performed for cervical spinal cord decompression and revealed a gouty tophus. Received for publication March 27, 2019; revision accepted July 12, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Berivan Emsen, MD, Department of Nuclear Medicine, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, 94 010 Créteil, France. E-mail: berivan.emsen@aphp.fr. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Differential 18F-FDG and 18F-Fluciclovine Uptake Pattern in a Patient With Poorly Differentiated Adenocarcinoma of the Lung and Prostate Cancer Biochemical Recurrence A 72-year-old man with a history of T1cN0M0 prostate adenocarcinoma and rising prostate-specific antigen underwent a fluciclovine PET/CT scan that showed high uptake in several para-aortic nodes, suspicious for prostate cancer. A right upper lobe single pulmonary nodule (SPN), demonstrated only mild uptake, which raised the suspicion for a lung primary. Subsequent FDG PET/CT showed high uptake in the SPN, revealing poorly differentiated adenocarcinoma at biopsy, but with no abnormal uptake in the para-aortic nodes. This case highlights the complementary potential of fluciclovine and FDG PET in patients with a history of prostate cancer biochemical recurrence and SPN. Received for publication May 2, 2019; revision accepted July 18, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Nghi C. Nguyen, MD, PhD, UPMC Presbyterian, East Wing, Suite 200, 200 Lothrop St, Pittsburgh, PA 15213. E-mail: Nncc.nguyen@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Complete Spontaneous Regression of Hepatosplenic T-Cell Lymphoma After Surgical Biopsy 18F-FDG PET/CT for a 74-year-old man with elevated serum soluble interleukin 2 receptor showed multiple intense uptake in the liver, spleen, and bone. A surgical biopsy from 2 of liver tumors confirmed hepatosplenic αβ T-cell lymphoma. One and a half months after biopsy, FDG PET scan was performed again for staging before starting chemotherapy, and it showed the complete disappearance of all of the lesions. The excisional biopsy could be a possible trigger of his spontaneous regression. Received for publication May 18, 2019; revision accepted July 18, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Ryusuke Nakamoto, MD, PhD, Shiga General Hospital, 5-4-30, Moriyama, Shiga 524-8524, Japan. E-mail: inabook.h2so4@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Breast Cancer Imaging With PET Based Radiopharmaceuticals Other Than 18F-FDG Breast cancer is the most common cancer in women with rising incidence worldwide. 18F-FDG PET/CT imaging has already established itself as a pivotal modality for staging, restating and response assessment in patients with carcinoma breast. The complex biology of this cancer is increasingly being decoded and various molecular targets have been identified and exploited for guiding the treatment at various time points during the course of the disease. We here depict a series of various metabolic and receptor targeting PET radiotracers in breast cancer patients which may help us understand the in vivo biology of this tumor. Received for publication April 26, 2019; revision accepted July 21, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Bhagwant Rai Mittal, MD, Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail: brmittal@yahoo.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Asymptomatic Metastasis to Thyroid Cartilage Detected by 18F-Choline and 64Cu-PSMA PET/CT as a Single Site of Disease Relapse in a Patient With Castration-Resistant Prostate Carcinoma Metastatic involvement of the larynx is rare due to the absence of vessels within the cartilaginous tissue. The probability of metastatic spread increases with aging as a result of larynx ossification. The secondary involvement of larynx is more frequently associated with melanoma and renal cell carcinoma. Few observations have been reported also in prostate cancer patients, usually associated with advanced disease and diffuse metastatic bone involvement. We report a case of an 83-year-old man with castration-resistant prostate cancer in whom a metastasis to the thyroid cartilage was the only site of relapse. Received for publication July 4, 2019; revision accepted July 20, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Alessio Annovazzi, MD, Nuclear Medicine Unit, IRCCS—Regina Elena National Cancer Institute Via Elio Chianesi, 53, 00144, Rome, Italy. E-mail: alessio.annovazzi@ifo.gov.it. ORCID ID: 0000-0002-4887-7982 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Great Mimicker—Tuberculosis Involving Prostate and Vertebrae Posing as Metastatic Prostate Carcinoma on FDG PET/CT A 65-year-old man underwent FDG PET/CT for evaluation of vertebral lesions, radiologically suspected to be metastases. The scan showed hypermetabolism in D8 to D9 vertebrae, retroperitoneal lymph nodes, and both the lobes of prostate. Transrectal ultrasound-guided biopsy of prostate was performed with suspicion of prostate malignancy. The biopsy revealed caseating granulomatous lesions in prostate suggestive of tuberculosis. Post antitubercular treatment patient showed excellent clinical response. Possibility of infective pathologies mimicking malignancy should be kept in mind while evaluating hypermetabolic foci seen on PET/CT. Although rare, tuberculosis of prostate needs consideration in differential diagnosis of FDG-avid foci seen in prostate. Received for publication June 8, 2019; revision accepted July 19, 2019. Conflicts of interest and sources of funding: none declared. This work was performed at Kamalnayan Bajaj Hospital, Aurangabad, India. Correspondence to: Prathamesh Joshi, DRM, DNB, Department of Nuclear Medicine and PET/CT, Kamalnayan Bajaj Hospital, Beed Bypass Rd, Aurangabad, Maharashtra 431010, India. E-mail: drprathamj@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

18F-Fluorocholine PET/CT Imaging of Brown Tumors in a Patient With Severe Primary Hyperparathyroidism Brown tumors are rare skeletal anomalies occurring in patients with hyperparathyroidism and exposing patients to pathological fractures. We report the case of a 26-year-old woman with severe primary hyperparathyroidism (calcemia, 2.9 mmol/L; parathyroid hormone, 59 pmol/L) who underwent 18F-fluorocholine (FCH) PET/CT before parathyroidectomy. FCH PET localized the hyperfunctioning parathyroid gland and showed multiple foci in correspondence with bone lytic lesions on CT. Those lesions were not visible on the 99mTc-MIBI dual-phase scintigraphy. The pathology of one of the FCH-positive bone lesions corresponded to a brown tumor related to hyperparathyroidism. Received for publication May 4, 2019; revision accepted August 5, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Jules Zhang-Yin, MD, Médecine Nucléaire, Hôpital Tenon & Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France. E-mail: tianyuzhang777@msn.com. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Spectrum of 18F-FDG Uptake in Bilateral Lung Parenchymal Diseases on PET/CT Bilateral lung parenchymal involvement is seen in infective as well as noninfective conditions, appearing as focal or diffuse lung disease. PET/CT with FDG helps in characterization (increased glucose utilization is seen by both inflammatory and neoplastic cells). In this article, we describe the spectrum of patterns of FDG uptake and associated CT changes involving bilateral lung parenchyma. Benign conditions described are aspiration pneumonia; pulmonary toxicity by bleomycin; infections, namely, sarcoidosis, miliary pulmonary tuberculosis, and pulmonary nocardiosis; and inflammatory conditions such as pulmonary Langerhans cell histiocytosis and pulmonary alveolar proteinosis. Neoplastic conditions described are bilateral pulmonary metastases and lymphangitic carcinomatosis. Received for publication March 11, 2019; revision accepted July 1, 2019. Conflicts of interest and sources of funding: none declared. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived. Correspondence to: Rakesh Kumar, MD, PhD, Department of Nuclear Medicine, AIIMS Campus, E-81, Ansari Nagar (East), New Delhi 110029, India. E-mail: rkphulia@yahoo.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pituitary Adenoma on 18F-Fluciclovine PET/CT A 69-year-old man presented with lower urinary tract symptoms and prostate biopsy showed prostate cancer. 18F-Fluciclovine PET/CT revealed abnormal increased radiotracer uptake within the prostate gland, and multiple osseous structures, suspicious for tumoral involvement. Incidentally, an expansile soft tissue density mass arising from sella turcica demonstrated increased radiotracer activity. MRI showed a lobulated enhancing mass centered in the sella and eroding into the sphenoid sinus. The differential diagnosis includes pituitary macroadenoma versus prostate cancer metastasis. The tumor was resected and the pathological diagnosis was pituitary adenoma. Received for publication May 3, 2019; revision accepted July 13, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Jiaqiong Wang, MD, PhD, Division of Nuclear Medicine, Department of Radiology, Miller School of Medicine, University of Miami Hospital/Jackson Memorial Hospital. Nuclear Medicine, Central 248 JMH, 1611 NW 12th Avenue, Miami, FL 33136, USA. E-mail: jiaqiong.wang@jhsmiami.org. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.